Kidney patients have an extremely complex situation where there are various different treatments they may need depending on their condition. But many patients, particularly elderly ones, may not be getting the proper options.

Reuters reports on how kidney patients need better options.

Patients are often not told why or whether they need dialysis, pills, insulin shots or sometimes a transplant.

Discussing treatment options and what will happen in the future with health providers is essential for patients with kidney disease, according to a new study. The study based its analysis on interviews with older late-stage kidney patients, researchers found differences in their understanding of what conservative management means, and of the advantages and advantages of choosing that route over dialysis.

Dr. Crine, who led the study, told Reuters, “Conservative management is an important alternative to dialysis for some adults with chronic kidney disease. But little is known about what patients with chronic kidney disease think about conservative management.” Dr. Crine also said that understanding why patients go for certain or different treatments could help clinicians provide care that is more focused on the patient.

How was the study conducted?

The study was published in the American Journal of Kidney Diseases. The researchers interviewed over 40 patients from nine kidney departments in English hospitals that provide dialysis. The people in the study had advanced kidney disease. The study team divided them into three groups based on their care: those presently going through dialysis treatments, those preparing for dialysis care or those who had chosen for conservative management.

The experts asked patients about their knowledge of their condition and treatments, as well as how and why they chose the treatment options they did. A number of the patients who opted for conservative care or had not yet started dialysis thought their symptoms were caused by other health problems and not the kidney disease. All of the patients knew what dialysis was, but in general, patients who opted for dialysis knew barely anything about conservative management.

Dr. Crine told patients that from units with a more structured conservative management pathway were more aware of conservative management, not as often believed that dialysis would confirm longevity and often had discussed the future with medical health specialists.

Dr. Crine said that, “Patient beliefs about treatment options appeared to be influenced by information provided by renal unit staff, particularly whether patients were aware of conservative management as an option. Whilst conservative management can be a difficult topic to discuss, renal unit staff may benefit from further training and support to enable them to present this as an option for patients who may not benefit from dialysis.”

Many experts commented on the study.

Dr. Schell, an expert in the field of nephrology told Reuters that dialysis in older patients, particularly patients with high co-morbidities, may not benefit quality of life but also may not improve longevity

Schell, a nephrologist, said, “I think this article highlighted a gap in how we take care of these patients. And it rings true that we need to have a concerted effort to identify patients who would benefit from a conservative approach and talk to them in a way that they fully understand the risks and benefits. We start the conversations when patients enter late stage four or stage five, which would be near dialysis time adding that some people can stay in those stages for quite some time.”

Dr. Schell also admitted that this is a teaching point for physicians that whether the patient decides to do dialysis or not, this is an ongoing conversation.


Gerry Oginski
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